Lateral orbitotomy for intraconal lesions: a ten-year single-center experience with surgical technique and clinical...

Intraconal orbital tumors pose significant surgical challenges due to their deep anatomical location and close relationship with critical neurovascular structures. Although the lateral orbitotomy approach (LOA) offers direct access to the intraconal space, comprehensive outcome data from single-center experiences remain limited. This study aimed to evaluate the clinical characteristics, surgical outcomes, and safety profile of patients with intraconal orbital tumors treated via LOA over a ten-year period.

A retrospective analysis was conducted on 27 patients who underwent lateral orbitotomy for intraconal lesions at Gazi University Hospital between January 2013 and January 2023. Patient demographics, presenting symptoms, tumor characteristics, extent of resection, postoperative outcomes, and complications were analyzed.

The cohort consisted of 27 patients, including 12 males and 15 females, with a mean age of 41.0 years. The most common presenting symptoms were exophthalmos (92.6%), visual loss (63.0%), pain (33.3%), and diplopia (25.9%). Cavernous hemangioma was the predominant pathology (77.8%). Gross total resection (GTR) was achieved in 22 patients (81.5%), with significantly smaller tumor volumes compared with the subtotal resection (STR) group (p = 0.0033). All small tumors (< 4.0 cm³) underwent GTR, whereas the rate declined in medium and large tumors (p = 0.0031). Postoperatively, most symptoms improved. Transient postoperative events occurred in 37.0% of patients, most commonly palpebral swelling. No severe complications, or surgery-related mortality were encountered during a median 48-month follow-up.

Lateral orbitotomy is a safe and effective approach for intraconal tumors, providing high GTR rates, consistent symptom improvement, and low morbidity. Its reliable access to lateral and central intraconal compartments supports its continued use in orbital surgery.